Archive for July, 2012

Office of Civil Rights (OCR) Publishes The Audit Protocol

On June 25, OCR published the audit protocol that is being used in the current round of privacy and security audits. The audit protocol includes 165 “key activities” (88 related to the Security Rule, 10 related to Breach Notification, and 78 related to the Privacy Rule).

New Rules on EFT and ERA Expected Soon

New federal rules to tighten the HIPAA transactions for electronic funds transfer and electronic remittance advice are expected soon.

The Centers for Medicare and Medicaid Services has sent an interim final rule establishing “operating rules” for EFT and ERA to the Office of Management and Budget. OMB review is one of the last steps before publication of a rule.

The Affordable Care Act mandates adoption of a series of rules between 2013 and 2016. These include operating rules for eligibility and claim status in 2013, EFT and ERA in 2014, and claims/encounters, coordination of benefits, enrollment/disenrollment, premium payments, attachments, and referral certification and authorization in 2016.

CMS Releases 2013 Proposed Physician Fee Schedule Rule

The Centers for Medicare & Medicaid Services (CMS) released the Medicare proposed physician fee schedule (PFS) rule for 2013. CMS will accept public comments on the rule until Sep. 4, 2012, and intends to issue the final rule by Nov.1, 2012.

CMS states that the actual values used to compute physician payments for CY 2013 will be based on later data and are scheduled to be published by Nov. 1, 2012 as part of the CY 2013 PFS final rule. CMS estimates an approximate 27 percent physician payment cut due to the sustainable growth rate formula (SGR).